NHS IN CRISIS: Don’t get ill or head online to save NHS millions say health bosses

Forget “Physician Heal Thyself”, plans to shake up health services and save the NHS millions seem to hinge on patients either not getting ill in the first place or looking after themselves with an increased use of technology.

However, campaigners are warning of the dangers of the tech revolution and say patients will suffer if health bosses try to replace them with apps.

Helen Stokes-Lampard, chairman of the Royal College of GPs

A leading GP believes the health service is gambling millions on plans to use apps, benevolent Big Brother-style monitoring devices and video-link surgeries to bridge a five-year funding gap.

Health bosses around the UK are drawing up plans to shake up the patient-doctor relationship by limiting “face-to-face” interactions, both in the NHS and in drastically under-funded council-run social care.

An investigation by The i and sister Johnston Press titles has found all 44 Sustainability Transformation Plans (STP), produced by regional NHS bodies, plan to meet strict five-year savings targets by increasing the use of new digital technologies to deliver health services.

Regions are proposing to increase “virtual appointments,” where patients can talk to their GP, or take part in a group therapy session via video-call.

“Artificial intelligence” apps are already starting to deliver diagnoses on the private market and are already being discussed by Clinical Commissioning Groups (CCGs) looking to assess patients without the need for a face-to-face meeting.

But leading GPs are not convinced the move is the magic formula in helping the NHS meet its £22 billion shortfall.

Helen Stokes-Lampard, chairman of the Royal College of GPs, believes video-link doctors’ appointments could actually increase their workloads.

She said: “While these might be convenient, they don’t actually reduce a GP’s workload as a 10-minute patient consultation takes 10 minutes whether face-to face-or over the phone - and in some cases virtual consultations can increase workload, if a follow up face-to-face consultation is necessary.”

Mrs Stokes-Lampard says she broadly supports the idea of increasing technology in the NHS, but she fears it could alienate patients who are not “tech savvy.”

She said: “Whatever happens, the GP-patient relationship is unique in medicine and there is no app, algorithm or technological innovation that can, or will, replace it in the foreseeable future.”

All 44 STPs are seeking to drastically reduce accident and emergency admissions, scheduled visits and “face-to-face” care in part, by moving towards a model of what has been labelled “self care.”

Vice-president at the Royal College of Emergency Medicine, Chris Moulton, believes types of preventive treatment are “absolutely the morally and medically correct thing to do.”

But he warned they should not be used as a way of saving the NHS money.

He said: “When a 60-year-old person takes statins and other drugs to avoid having a heart attack, they don’t sign a pledge saying that they will never use the health service again for the next two decades.

“Using lifestyle changes and medical interventions to prolong happy lives is the right thing to do. But it is not the answer to the financial crisis facing the NHS.”

In adult social care the STPs talk of plans to increase “telecare,” where elderly or disabled people can be monitored by devices in their own home.

FLAWED

One union leader fears the ploy, which campaigners fear is a move for cash-strapped councils to reduce home visits, is flawed.

Guy Collis, health policy officer at Unison, said new technology would require staff to undergo extensive, costly raining, before it is rolled out.

“I think too often there’s this idea that they can be a quick shortcut for savings or improving patient experiences,” he said. “That’s all well and good as long as you have the right people.

“The NHS doesn’t have a great track record for IT.”

On the other hand director of innovation at national charity Carers UK, Madeleine Starr MBE, said the move to self-administered healthcare is “inevitable” considering the huge deficit in the NHS.

Patients, she believes, will simply need to adjust.

“We need to move away from the idea that a GP is a sacred cow you’ve got to sit in front of,” she said.

“You are never not going to need an expert when the time comes. But very often the GP is not providing expert support. Much of the time they are simply answering questions.”

Mrs Starr believes also new innovations in home “telecare” will be key to reducing the workload of carers.

The UK, she says, is languishing behind other developed nations, such as Japan, which is already rolling out “carebots” that can detect falls , assist mobility and provide company.

Brand names set to be more prevalent in the home care market including Canary, Oysta and JustChecking are now purporting to offer much more than the current neck-worn emergency buzzers and toilet pull cords - which have been in circulation for a number of years.

As a result, cash-strapped councils, which have the responsibility for looking after vulnerable adults and the elderly in their areas, are keen to increase their use of monitoring tech.

One of the forerunners, Hampshire County Council, claims to have trimmed £4.7 million from its budget since entering into a telecare partnership with London-based PA Consulting.

Northamptonshire County Council, which is set to cut £24 million from its 2017/18 adults care budget alone, is preparing to put more Canary devices in homes.

Aside from the savings Editor of OurNHS, OpenDemocracy, Caroline Molloy says GPs have deep concerns that a move away from “face-to-face contact with a GP will see patient’s ailments missed.

She said: “The real thing they worry about comes out of that lack of human interaction.

“I’ve had people who are strong advocates of this sort of thing admit they are worried.

“As soon as you are not seeing someone in a room in front of you - you are losing out on their skin colour, their smell, whether they are looking after themselves properly, whether they are tapping their foot under the table because they are not giving you the full picture.

“All of these little clues are really important.”

She also believes the sheer capital costs needed to invest in the new software could negate any savings benefit as well.

In Milton Keynes, Bedfordshire and Luton, the STP for the area budgets for a £12 million “digital investment” over the next five years.

But the jury is also out on the effectiveness of apps that used to remotely monitor people with mental health conditions.

Scientists at the University of York said a trial of mood-monitoring therapy software, where patients update a system with how they are feeling at a given time, showed it offered “little or no benefit over usual GP care,” as many users were not willing to log in of their own accord.

FACT BOX:

What the STPs say:

*Health bosses in South East London are proposing to introduce “algorithmic decision support tools” - to aid its 1.67 million population and to have “universally deployed digital alternatives to face to face care in primary care and outpatient services.”

In North London the STP announces plans to create a “population health management system” equipping people living in the capital with tools “which enable them to actively manage their own health and wellbeing.”

In Hull, the commissioning group has secured funding for new “assistive technologies” such as environment monitors, medication dispensers, and “talking devices.”

In nearby Rotherham patients will be encouraged to take their blood pressure at home and text their result to the practice - who would then take action if the result is out of range.

In the west of England, leaders in Bristol, North Somerset and South Gloucestershire seeking to introduce online “virtual therapy” and “symptom and medication” monitoring within the next two to three years.

STATS

Why health services want to digitise care:

*73 homes cancelled their registration in the first six months of 2016, according to the Care Quality Commission

*Between 2015 and 2016, 648 care home beds were lost due to closures.

*The Office for National Statistics predicts councils across the UK will need to find £2billion over the next five years to meet their statutory duties in looking after the elderly and those in need.

*Hertfordshire County Council claims to have saved 4.7million since entering a telecare partnership

*South East London STP area believes it can save £150m by setting up a real time information sharing system for end of life care.

*GPs are currently making 370 million patient consultations every year, which is 60 million more than five years ago.

*Going “paperless” could save the NHS “billions” by 2018, according to Health Secretary Jeremy Hunt.

*The average waiting time to see a GP is currently 13 days.

*7,687 residents living in 248 residential and nursing homes in Bradford, Airedale, Wharfedale, Craven and East Lancashire are currently the focus of a study into increasing the use of telecare.